Healthcare Provider Details

I. General information

NPI: 1245207430
Provider Name (Legal Business Name): HARSHA BHAGTANI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9101 FRANKLIN SQUARE DR SUITE 205
BALTIMORE MD
21237-3936
US

IV. Provider business mailing address

1030 S JEFFERSON ST STE 106
ROANOKE VA
24016-4418
US

V. Phone/Fax

Practice location:
  • Phone: 443-777-2000
  • Fax:
Mailing address:
  • Phone: 540-985-8230
  • Fax: 540-343-1012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101263733
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: